Two of Devoted Health's MA plans earned 5 stars during a difficult year for star ratings
"We take our members and treat them really, really nicely," says CMO Neil Wagle.
Devoted Health CMO Neil Wagle
Photo: Courtesy of Devoted Health
In the most recent Medicare Advantage star ratings, some of the bigger plans failed to get the 5 stars they had previously earned.
The drop from 57 plans earning 5 stars in 2023 to 31 in 2024 was called the "final fallout" from COVID-19, as CMS returned to a more business-as-usual approach – and stricter methodology – after relaxing measures during the pandemic.
The Waltham, Massachusetts-based Devoted Health, which now offers Medicare Advantage in 13 states, had two plans that earned the top rating.
"The thing that stood out to me was Devoted Health," Ashley McNairy, senior product director at Cotiviti said after the ratings were released. "It's the fastest growing MA plan."
Ninety-four percent of Devoted members are in MA plans that rank at 4 stars or higher, according to CMO Neil Wagle, who runs the company's clinical arm.
Most members are in a plan that has a 4.63 average weighted star rating.
The way they do this, he said, is "We take our members and treat them really, really nicely," Wagle said.
This shows in CAHPS measures, the Consumer Assessment of Healthcare Providers and Systems survey, which now accounts for more than 30% of a health plan's rating.
Patient experience is the company's "prime directive," Wagle said. "We pick up the phone within 30 seconds. Our members call us a lot, on average once a month. They start out, 'That person was so nice.' When it happens again, again and again, they say, Devoted is offering something different."
The way the integrated vertical physician/payer model works, members get to keep their primary care physician.
Devoted medical staff are fully employed. There's no bill for the patient.
Most Devoted MA plans are zero premium and provide vision, dental and hearing benefits. All of the medical care is free. Patients are not billed for primary care.
"We offer a coordinated customized solution to do whatever it takes to support primary care, wellness, chronic care, palliative care … we have 19 distinct clinical service lines," Wagle said.
Physicians are not scheduling patients in 15-minute increments but can take an hour if needed.
Devoted calls members to remind them of wellness appointments to schedule, for example, mammograms.
"We build that therapeutic alliance," Wagle said, "because that's what it takes to actually make a difference in somebody's health."
It also shows in cost. Devoted members have 41% less hospital expenses compared to numbers for original Medicare.
And it shows in investment. Devoted Health recently announced that it secured $175 million in Series E funding at the end of 2023.
WHY THIS MATTERS
The Medicare Advantage company was founded in 2017 by Todd Park – who previously cofounded Athenahealth and Castlight Health – and his brother Ed Park, who held top positions at Athenahealth. Ed is CEO of Devoted and Todd is chairman of the board.
They started with technology. Engineers purpose-built an all-in-one software platform, including the EHR, called Orinoco, after the second largest river in South America. The name of the longest river in South America, the Amazon, was already taken.
Orinoco is a proprietary single platform combining the EHR, claims, clinical decision support and more. Every referral, sales authorization, pharmacy claim that comes in goes through the system, which then "tells the provider what they need at the moment they do it," Wagle said.
"The way we do that is through process control," Wagle said. "We make sure we do all the things that science knows, making sure we do that every time. The software we've purpose built for this. We are very very reliable in doing the things we know how to do."
Financially, Devoted's business model is similar to any vertically aligned payer and provider where the company is able to invest in preventive care to prevent costly downstream acute care.
It makes its money as does any other Medicare Advantage plan, by receiving a set amount from the federal government each month.
THE LARGER TREND
Devoted has 124,000 members in 13 states and plans to expand.
It currently operates in Alabama, Arizona, Colorado, Florida, Hawaii, Illinois, North Carolina, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee and Texas.
"We believe that by continuing to offer exceptional service that actually delivers the personalized care that seniors expect and deserve, we will keep attracting new members to the Devoted family in 2024," Wagle said. "We want to transform healthcare in this country. We want to go nationwide and beyond the walls of this country."
X: @SusanJMorse
Email the writer: SMorse@himss.org
